Allergy to ceftriaxone and features of cross-reactivity of cephalosporins: an еxperience in specific diagnosis of perioperative anaphylaxis

The development of new effective drugs has contributed to improving the quality of life and increasing its duration, but at the same time has led to an increase in drug hypersensitivity, including one of its most dangerous manifestations – anaphylaxis. Beta-lactams, and among them cephalosporins, and especially ceftriaxone, are among the leaders in the Russian Federation both in terms of frequency of prescription by various specialists, and among the causes of anaphylaxis and mortality associated with it. Anaphylaxis deserves special attention in the perioperative period, when the acute development of a life-threatening condition leads to cancellation of the operation or severe complications. To prevent recurrences of anaphylaxis, it is necessary to determine its specific cause, which often remains unclear, since several drugs are administered simultaneously and, in addition, there is contact with latex, components of medical equipment, etc.

The article describes a specific examination of a patient whose surgery was canceled due to the development of anaphylactic shock in the preoperative period after the administration of ceftriaxone and lidocaine. Using a clinical example, modern approaches to skin and provocation testing for diagnosing drug allergies and selecting the safest beta-lactams are presented, and the interpretation of results of determining the cross-reactivity of cephalosporins with identical R1 side chains, but different R2, is demonstrated. The examination made it possible to establish the cause of anaphylaxis and outline the range of drugs that are safest for the patient, including several beta-lactams as the drugs of choice for perioperative antibiotic prophylaxis and treatment of bacterial infections, if necessary.